Prof Richard Ashcroft
Doing the Right Thing for the Wrong Reason? The Morality of Changing People’s Behaviour by Paying Them
14 December 2011
There are a number of initiatives worldwide which aim to promote healthy living, compliance with medical or other official advice, or uptake of public services by offering patients, service users and citizens structured personal financial incentives. Examples include incentives to give up smoking, take regular exercise, stay drug-free, or (especially in the developing world) to ensure children’s attendance at primary school or to agree to long-acting contraceptive injections. Some of these objectives are inherently controversial or even immoral; but most are not. Nonetheless the schemes are often controversial even where their objectives are not. The use of money as an incentive seems to involve a problematic attitude to the person receiving the incentive on the part of the payer. But it also seems to involve the payee acting for the wrong (type of) reason. Surely I should give up smoking because I want to give up, not to get hold of some money? And surely I should make sure my child goes to school because it is good to go to school? In this paper I want to examine more deeply this type of objection to incentive schemes: what is it to “do the right thing for the wrong reason”? And when, if ever, do incentive schemes truly fall foul of this objection?
Richard Ashcroft is Professor of Bioethics in the School of Law at Queen Mary, University of London, and Co-Director of the Centre for the Study of Incentives in Health, funded by the Wellcome Trust.